An Enlarged Prostate @50plus

Are you 50plus? Have you started to get up in the night to go to pee? When you get there are you having problems with your flow? Is it a little weaker than it used to be? Even after you've been, do you have that feeling that you haven't emptied your bladder? If the answer is yes to any or all of these questions then you my friend may be suffering from an enlarged prostate otherwise known as Benign Prostatic Hyperplasia (BPH).

Photo by Giorgio Trovato on Unsplash


Photo by Jasmin Sessler on Unsplash

Before we go any further let's get this out in the open. An enlarged prostate is not cancerous. It is not a precursor to prostate cancer. You can have both, but because you have one doesn't mean that you're going to get the other.


Most men over 50 will at some point or other develop an enlarged prostate. 50% of men between 51-60 have an enlarged prostate. At 80 years of age, that figure goes up to 90% of men.

So if you're a man and you live long enough you're likely to develop an enlarged prostate. Now we've got that out of the way, an enlarged prostate what is that?


What is an enlarged prostate?


The prostate is a walnut-sized gland that sits below a man's bladder. Its main purpose is the production of seminal fluids. The urethra runs through the prostate gland from the bladder to the penis. For some reason and nobody actually knows why ( although some think it may be to do with the hormonal changes that come with ageing) as men get older the cells in the prostate begin to multiply. Another way to say it is that your prostate starts to grow. As it grows the prostate starts to put pressure on the urethra. This increase in pressure can start to collapse the urethra and hey presto you have the problems with urination mentioned above.



BPH symptoms

I have already mentioned some of the most common symptoms above but here is a more complete list:

  • incomplete bladder emptying

  • nocturia, which is the need to urinate two or more times per night

  • dribbling at the end of your urinary stream

  • incontinence, or leakage of urine

  • the need to strain when urinating

  • a weak urinary stream

  • a sudden urge to urinate

  • a slowed or delayed urinary stream Photo by pan xiaozhen on Unsplash

  • painful urination

  • blood in the urine

The symptoms of BPH are often very mild at first, but they become more serious if they aren’t treated so talk to your doctor immediately if you have any of these symptoms. Men who have a long-standing history of BPH may develop the following complications:

  • urinary tract infections

  • urinary stones

  • kidney damage

  • bleeding in the urinary tract

  • a sudden inability to urinate

Although as I have said most of the symptoms associated with BPH are not life-threatening there are some rare complications that require immediate medical attention. One of the most dangerous of these is acute urinary retention (AUR). This is the sudden inability to pass any urine.

Symptoms of AUR include:

  • suddenly not being able to pee at all

  • severe lower tummy pain

  • swelling of the bladder that you can feel with your hands

BPH diagnosis

Photo by Retha Ferguson from Pexels

When checking you for BPH, your doctor will usually begin by doing a physical exam and asking you about your medical history. The physical exam includes a rectal examination that allows the doctor to estimate the size and shape of your prostate.

Other tests can include:

  • Urinalysis: Your urine is checked for blood and bacteria.

  • Prostatic biopsy: A small amount of prostate tissue is removed and examined for abnormalities.

  • Urodynamic test: Your bladder is filled with liquid via a catheter to measure the pressure of your bladder during urination.

  • Prostate-specific antigen (PSA) test: This blood test checks for cancer of the prostate.

  • Post-void residual: This tests the amount of urine left in your bladder after urination.

  • Cystoscopy: This is the examination of your urethra and bladder with a tiny lighted scope that is inserted into your urethra

  • Intravenous pyelography or urography: This is an X-ray exam or CT scan that is done after a dye is injected into your body. The dye highlights your entire urinary system on the images produced by the X-ray or CT.

Your doctor may also ask about medications you’re taking that might be affecting your urinary system, such as:

  • antidepressants

  • diuretics

  • antihistamines

  • sedatives

Your doctor can make any necessary medication adjustments. Don’t attempt to adjust your medications or doses yourself. Let your doctor know if you’ve taken self-care measures for your symptoms for at least two months without noticing any improvement.

BPH natural treatment

Natural treatment can include specific actions or lifestyle changes that you can make to help relieve your symptoms of BPH. These include:

Photo by Dustin Belt on Unsplash

  • urinating as soon as you feel the urge

  • going to the bathroom to urinate, even when you don’t feel the urge

  • avoiding over-the-counter decongestants or antihistamine medications ( this includes Diphenhydramine (Benadryl); Loratadine (Alavert, Claritin); basically all over the counter allergy medication) which can make it harder for the bladder to empty

  • avoiding alcohol and caffeine, especially in the hours after dinner

  • reducing your stress level, as nervousness can increase the frequency of urination

  • exercising regularly, as a lack of exercise can aggravate your symptoms

  • learning and practising pelvic floor strengthing (Kegel)

  • keeping warm, since being cold can make symptoms worse

Catheters.

If you continue to have trouble peeing, (chronic urine retention) you may need a catheter to drain your bladder. A urinary catheter is a soft tube that carries urine out of the body from the bladder. It can be passed through your penis, or a small hole made in your tummy, above your pubic bone.


You may be recommended a removable catheter or a catheter that stays in your bladder for a longer period.


Some people also include natural remedies in their treatment of BPH but there is limited evidence as regards their effectiveness so I am not going to mention them here.



BPH drugs

When lifestyle changes aren’t enough then your doctor may recommend medication. Amongst the most commonly used medications are;


Alpha-1 blockers are medications that relax the muscles of the bladder and prostate. Alpha-1 blockers relax the neck of the bladder and make it easier for urine to flow.


Hormone reduction medications that reduce the levels of hormones produced by the prostate gland, such as testosterone, can be prescribed. Lowering the hormone levels can shrink the prostate improving urine flow. (Note: these medications can have unwanted side effects such as impotency and a decreased sex drive).


Antibiotics may be used if your prostate becomes chronically inflamed from bacterial prostatitis related to BPH. Bacterial prostatitis is a condition in which a bacterial infection develops in the prostate gland.

Surgery and other procedures currently available on the NHS


Most men with urinary symptoms do not need to have surgery, but it may be an option if other treatments have not worked.

Transurethral resection of the prostate (TURP) involves removing part of the prostate gland using a device called a resectoscope that's passed through the urethra (the tube through which urine passes out of the body). It's suitable for men who have an enlarged prostate.


Open prostatectomy, the prostate gland is removed through a cut in your body. It's suitable for men who have an enlarged prostate over a certain size. See our blog on prostate cancer and radical prostatectomy.


Prostatic urethral lift (PUL) implants. A surgeon inserts implants that hold the enlarged prostate away from the urethra, so it is not blocked. This helps to relieve symptoms such as pain or difficulty when peeing.


Cystoplasty is a procedure to increase the size of the bladder by sewing a piece of tissue from the intestine into the bladder wall. This may help men whose bladder muscle contracts before it's full.

Prostate artery embolisation A catheter is inserted into an artery in your groin or wrist. Using X‑ray guidance, it's passed into the blood vessels that supply the prostate gland.

Tiny plastic particles are injected into these vessels to reduce the prostate gland's blood supply, which shrinks it. The potential benefits of prostate artery embolisation compared with surgery are fewer complications and you can have this procedure under local anaesthetic as an outpatient.


Botulinum toxin. This procedure involves injections of botulinum toxin into the walls of your bladder. It may help men whose bladder muscle contracts before the bladder is full.


Implanted sacral nerve root stimulation. A small electrical device is implanted under your skin and sends bursts of electrical signals to your bladder and urine system for better control. This is suitable for men whose bladder muscle contracts before their bladder is full.


Urinary diversion involves linking the tubes that connect your kidneys to your bladder directly to the outside of the body, so urine can be collected without flowing into your bladder.

This is suitable for men whose symptoms cannot be controlled by self-management and medicine, and who cannot have – or do not want – cystoplasty or sacral nerve root stimulation.

Water ablation is a new treatment for prostate enlargement. There are 2 types of water ablation procedure. In the first, water is injected into the prostate using a probe passed up the urethra. The pressure of the water is then used to destroy some of the prostate tissue, making it smaller. The second type is very similar except steam, rather than water, is used to destroy prostate tissue. Water ablation is probably less likely to cause side effects than a transurethral resection of the prostate (TURP). (Note: not all NHS surgeons are currently trained to perform these procedures, so access to them may be limited and waiting lists may be longer than for other surgical options).

Conclusion

BPH doesn’t always require medical treatment. Sometimes, you can get away with regular checkups to monitor your symptoms and the size of your prostate. Lifestyle changes, medication, and surgery are all treatment options for symptoms that are affecting your quality of life. Don't suffer in silence. If you think something is wrong, go to your doctor and get things checked out. Don't wait. Act!


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